US20210085528A1 - Externally-applied patient interface system and method - Google Patents

Abstract

A surface-wound healing dressing for a wound or incision includes a slip drain located within the closed wound or incision. A wick is placed over the closed wound or incision in contact with the slip drain. A mat is placed over the wick and adapted for fluidic communication therewith. A recoil core includes a foam material and is adapted for placement on the mat. A wound healing method includes the steps of placing a slip drain, placing a wick over the slip drain, placing a recoil core over the wick and covering the recoil core with an overdrape. The overdrape is adapted for connection to an external negative pressure source, such as a vacuum.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a Continuation of U.S. Non-Provisional patent application Ser. No. 15/979,819, filed May 15, 2028, which is a Divisional of U.S. Non-Provisional patent application Ser. No. 14/442,388, filed Nov. 12, 2013, which claims priority in International Application No. PCT/US2013/069756, filed Nov. 12, 2013, which claims priority in U.S. Provisional Patent Application No. 61/725,412, filed Nov. 12, 2012, all of which are incorporated herein by reference.
• The following patents are incorporated herein by reference: U.S. Pat. No. 6,951,553, issued on Oct. 4, 2005; U.S. Pat. No. 6,936,037, issued on Aug. 30, 2005; U.S. Pat. No. 7,976,519, issued on Jul. 12, 2011; and U.S. Pat. No. 8,956,335, issued on Feb. 17, 2015.
BACKGROUND OF THE INVENTION1. Field of the Invention
• The present invention relates generally to externally-applied wound dressings and wound closure methods.
2. Description of the Related Art
• Wound-dressing and wound-healing include what is known as “moist wound healing.” Three major components that constitute the external and physical environment of the healing wound should, in an ideal wound-healing environment, be controlled. First, wound healing is inversely related to bacterial growth. Second, it has been shown that, holding other variables constant, there is a clear linear relationship between the moisture level at the wound-site and the rate of epithelial advancement. The final important characteristic is the surface contact property of the wound dressing. The surface contact property can help to control the other two major factors. The contact layer must be made of a suitable material that promotes endurance of the dressing as well as comfort to the patient.
• Thin pieces of foam have been used in moist-wound healing applications. The external face of the thin foam was more open allowing for enough moisture retention initially, but then allowing drying to occur with the dressing still in place. The internal face (or tissue-contact face) had a compressed or less-open pore configuration. Because this foam did not adhere to the wound, it could be moved or removed without disrupting the epithelium. However, this practice was often limited to small incisions since the thin foam is incapable of managing a large amount of exudate from a large, fresh wound, and if exudate accumulates under the foam piece the foam will lose surface contact, which allows bacteria to build up. By preventing granulation ingrowth, the compressed surface allows epithelial migration to advance beneath the foam. However, this type of surface had even more problems staying in intimate contact with the surface, especially in the face of exudate.
• In general, epithelium advances or migrates best if moisture is maximized and then matures best if moisture is minimized. Although the idea of moist wound healing is not new, the perfection and maximization of the use of this healing process is far from perfected.
• Another important aspect of wound healing relates to the respective roles of the vascular and lymphatic circulatory systems, both of which are involved in wound healing, but perform different functions. An injury to tissue involves both vascular and lymphatic circulation. The vascular system clots due to the serum and platelets, which control bleeding. Lymph fluid, however, lacks comparable coagulating properties. Moreover, the smaller-channeled peripheral lymphatic system lacks the muscled walls of the vascular circulatory system or the more proximal large-channel lymphatics. Stemming the outpouring of lymph fluid from these smaller channels involves compressing the lymphatic circulatory system through surrounding tissue swelling from an accumulation of edema and interstitial fluid. Unlike the quick response of coagulating blood, lymphatic circulatory system closure tends to be slower and can take days.
• Based on the involvement of the vascular and lymphatic circulatory systems in wound healing, influencing the performance of these circulatory systems can significantly improve wound healing. Wound closure can be achieved more quickly and infection risks can be reduced by controlling the factors affecting vascular and lymphatic circulation. For example, increased perfusion of blood flow in the wound site generally promotes healing and reepithelialization. Individual cells are also responsive to mechano-inductive forces, such as compression and tension. Properly applied and sequenced, compression and tension can promote healing.
• The present invention addresses these wound healing factors by controlling and directing compression, tension and other physiological variables associated with the tissues and the fluids associated with the wound site and otherwise involved in the wound healing process.
SUMMARY OF THE INVENTION
• In the embodiments of the invention described in more detail below, the unique dressing and method accomplish the objectives of enhancement and protection of (re)epithelialization, both migration and maturation, without disruption of the fragile layer by undue adherence or by motion/friction/abrasion and yet maintaining the closest of surface contacts without intervening dead space or its consequence of fluid accumulation, lytic bleeding, and micro abscess formation and lack ultimately of the ability to dry and mature epithelium. This is done by drawing away air and liquid from the wound and by introducing fresh air and/or fresh liquid to the wound to expedite healing. In this embodiment, air and moisture levels at the wound-site can be balanced by using vacuum pumps to remove excess air or moisture, and input pumps can be used to add additional dry air or moisture, or a gas or other elements which enhance healing. The vacuum pump will also provide the necessary vacuum press effect, keeping the dressing against the wound in intimate contact and enhancing healing.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is an exploded view of an external dressing system embodying an aspect of the present invention.
• FIGS. 2-4 are cross-sections of the dressing system.
• FIG. 5 is an isometric view of an alternative embodiment dressing system with sutures over a recoil core.
• FIG. 6 is an exploded view of another alternative embodiment dressing system.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTSI. Preferred EmbodimentExternal Dressing System1102
• FIG. 1 shows the preferred embodiment external wound dressing system. A wound6, such as an incision, can be prepared by placing anexternal dressing1102 onto the wound. Thedressing1102 promotes healing at three levels of the wound repair continuum: healing (epithelialization) of an open wound, stability of a recently epithelized, but not matured, wound, and maintenance of a mature or intact epithelium without breakdown under a dressing. Thisdressing device1102 has the unique advantage that it can be applied for a short period of time (days) or left in place without changing for up to six weeks. This is possible because the wound removes old air and liquid from the wound-site and introduces fresh air and liquid to the wound-site to expedite the healing process.
• Theexternal dressing1102 can be configured with various components, which can be selected and configured for expediting and optimizing the healing procedure for various closed wounds and patient conditions. By way of non-limiting example, theexternal dressing1102 includes a surface contact layer orwick1104 comprising a wicking material layer, amat1106, apolyurethane foam core1108 with a lattice covering1110 and asemi-permeable film cover1112 overlying the other components.
• An optional, perforated tubular deep drain (not shown) can be placed in or in proximity to the wound6 andslip drains1116 can optionally be placed in the wound6. Suitable, optional closures for the wound6 includesutures1118, staples, adhesives, etc.
• Alternatively, a suitable direct-contact foam core1108 can be placed directly on theskin surface42 and simply covered with themembrane film cover1112. Still further, thefoam core1108 can be completely enclosed in a cover layer of a suitable material, such as a wicking material layer. Further still, the dressing1102 can be completely unitary and self-contained for direct placement, whereupon the pressure differential feature described below can fix the dressing1102 to the intact skin surface for proper positioning over the wound6.
• Thecore1108 can be placed on top of anoptional mat1106, which can be selected to cooperate with the wickingmaterial layer1104 in conveying fluid from the wound6. Thecore1108 can distribute vacuum pressure differential to thesurface contact layer1104. Thecore1108 is preferably collapsible and flexible and returns to its approximate original size and shape when vacuum pressure is removed. Without limitation, a suitable core material is an open-cell hydrophobic foam material which will maximize the above-listed desirable characteristics of thecore1108. This material can be integrated with thesurface contact layer1104. Other core materials may be used instead, such as hydrophilic foam, fiber matrix pads or a hybrid composite material comprising, e.g., beads and fibers.
• Thecover layer1112 covers the other components including thecompression core1108 and thesurface contact layer1104. Thecover layer1112 is preferably relatively thin and flexible so that it can be collapsed over theunderlying core1108 to distribute the atmospheric pressure differential to all covered areas. Suitable, commercially-available, semi-permeable membrane materials are discussed above.
• In an exemplary configuration, multipletop surface ports1120a,bare provided on top of thecover layer1112 and are connected tosuitable fittings1122 adapted for connecting to fluid-conveying tubing and conduits, which in turn connect to the equipment described below. Additional,perimeter ports1124a, bare provided in thecover1112 in proximity to the core perimeter and can be provided withtubular fittings1126.
• In operation the slip drains1116 would adhere to the adhesive on the underside (contact surface) of thecover layer1112 for extraction when the cover layer is removed, e.g., for a dressing change.
II. Closed-Wound Treatment Method withDressing1102
• As shown inFIGS. 2-4, the dressing1102 is generally adapted for use in a configuration providing internal compression and passive external resistance. More specifically and without limitation, the fluid forces and pressures generated and applied by the dressing1102 can be described as follows:
• The dressing1102 exerts a downward (compression) force against thecontact surface42 to which it is applied, i.e., generally around the incision6. Theskin42 and the tissue immediately beneath it are subject to an outwardly-directed lifting force due to the negative pressure in thedressing1102. These forces and pressures tend to cancel whereby the dressing1102 is in a compressed, balanced, equilibrium condition.
• The dressing1102 creates a pressure differential with respect to the surrounding ambient atmosphere and the dressing interior, exerting a compressive force corresponding to the ambient air pressure, which varies among different locations but tends to remain within certain well-known ambient air pressure ranges at given locations. The components within the dressing1102 are compressed relative to each other.
• Based on the balance of forces acting on the dressing1102 in a steady state, a relatively fixed butflexible dressing1102 tends to be firmly attached, i.e., molded, to theskin surface42 by the operation of the atmospheric pressure differential.
• The dressing1102 converts the overlyingintact skin42 from an elastic layer to a relatively inelastic layer, which effectively resists pressure changes below the skin.
• Pressure changes below theskin surface42 are provided by the following physiologic functions: a) arterial pulsation, which tends to be amplified by the inelastic characteristic of the dressing1102 coupled and cooperating with theskin42; b) muscle contraction, which also tends to be amplified by this inelastic characteristic of the system; and c) the leakage of tissue fluid and the buildup of edema, e.g., intracellular edema.
• Edema fluid buildup is the means by which leaking lymphatics are closed by compression. As pressure increases in the tissue from the buildup of edema fluid, the lymphatic vessels tend to be compressed. The dressing1102 facilitates the earlier compression by amplifying the effects of bleeding and edema fluid buildup. Thus, the normal lymphatic system compression response, which can take approximately3 days, can be significantly accelerated to the point that the edema phase is almost eliminated. Bacteria which appear over the several days of the normal edema phase are cleaned up in the wound site by macrophages and white cells which are also released into the wound over the several days. By eliminating the edema phase this entire inflammatory phase can also be eliminated. By achieving early reepithelialization, wound healing can be actually accelerated and the wound protected from bacterial invasion by this technique. Epithelial cells begin to move and migrate to the wound site based on the lymphatic system control. The edema formation and inflammation phases of normal wound healing can thus be avoided or at least minimized.
III. Alternative EmbodimentExternal Dressing System1130
• FIG. 5 shows an alternative embodiment external wound dressing1130 with acore1132, which can be encircled or otherwise in contact withsutures1134, which are connected to the slip drains1136.
IV. Alternative EmbodimentExternal Dressing System1140
• FIG. 6 shows another alternative embodiment external wound dressing1140 with a pair ofcores1142 positioned in end-to-end relation. Afilm bridge1144 covers abutting ends of thecores1142.
• It is to be understood that the invention can be embodied in various forms and is not to be limited to the examples discussed above. The range of components and configurations which can be utilized in the practice of the present invention is virtually unlimited.

Claims (21)

Having thus described the disclosed subject matter, what is claimed as new and desired to be secured by Letters Patent is:

1. A negative pressure wound therapy (NPWT) dressing assembly for a wound or incision, which comprises:

an external fluid transfer component including a porous recoil core and configured for placement over and extracting fluid from the wound or incision;

a semi-permeable overdrape placed over said external fluid transfer component, said overdrape including a perimeter configured for attachment to a skin surface around said wound or incision;

an internal fluid transfer component located in said wound or incision in fluidic communication with said external fluid transfer component; and

said recoil core configured for connection to a negative pressure source and having a compressed configuration for extracting fluid from said wound or incision under negative pressure.

2. The dressing assembly according toclaim 1, which includes:

said overdrape having an opening to said external fluid transfer component, said opening forming a discharge port for fluid extracted from said wound.

3. The dressing assembly according toclaim 2, which includes:

said external fluid transfer component including a wicking material cover over said recoil core;

said recoil core forming a fluid transfer zone at its outer surface adjacent to said wicking material cover; and

said fluid transfer zone being adapted for directing fluid from said wound or incision to said discharge port.

4. The dressing assembly according toclaim 1, which includes:

a wicking material layer between said wound or incision and said external fluid transfer component.

5. The dressing assembly according toclaim 4, which includes:

a porous, fluid-permeable mat between said wicking material layer and said external fluid transfer component, said mat and said wicking material layer configured for conveying fluid from said wound or incision to said external fluid transfer component.

6. The dressing assembly according toclaim 5, which includes:

said internal fluid transfer component comprising a drain strip having an internal portion located within said wound or incision and an external portion located externally thereto in fluidic contact with said external fluid transfer component via said wicking material layer and said mat.

7. The dressing assembly according toclaim 6, which includes:

said drain strip external portion configured for folding over the skin surface adjacent to said wound or incision and placement between and in contact with the skin surface and said wicking material layer.

8. The dressing assembly according toclaim 7, which includes:

multiple said drain strips positioned in spaced relation along said wound or incision; and

said external portions of said drain strips configured for adhesively attaching to the overdrape with the dressing assembly in place.

9. The dressing assembly according toclaim 6, which includes:

a suture encircling said external fluid transfer component and connected to said internal fluid transfer component.

10. The dressing assembly according toclaim 1, which includes:

inlet and outlet ports formed in said overdrape and configured for fluid inflow and outflow respectively.

11. The dressing assembly according toclaim 10, which includes:

said inlet and outlet ports formed in an outer surface of said overdrape.

12. The dressing assembly according toclaim 10, which includes:

said external fluid transfer component having a perimeter; and

said inlet and outlet ports formed in said overdrape at said external fluid transfer component perimeter.

13. A dressing assembly for a wound or incision, which comprises:

an external fluid transfer component configured for transferring fluid from the wound or incision;

said external fluid transfer component including a porous recoil core with a surface;

an overdrape placed over said external fluid transfer component, said overdrape having a perimeter configured for adhesive connection to a skin surface adjacent to said wound or incision;

an internal fluid transfer component configured for placement in said wound or incision in fluidic communication with said external fluid transfer component;

said fluid transfer component configured for connection to a source of negative pressure external to said dressing assembly;

a wicking material cover enclosing said core and including a perimeter edge;

said fluid transfer component having compressed and uncompressed configurations;

said porous core forming a fluid transfer zone at its outer surface and adjacent to said wicking material cover;

said fluid transfer zone configured for directing fluid from said wound or incision to said discharge port;

a wicking material layer configured for placement between said wound or incision and said external fluid transfer component;

said internal fluid transfer component including multiple drain strips configured for placement in spaced relation along said wound or incision;

each said drain strip having an internal portion configured for placement within said wound or incision and an external portion configured for placement external to said wound or incision in fluidic contact with said external fluid transfer component via said wicking material layer and said mat;

said drain strip external portions configured for folding over the skin surface adjacent to said wound or incision and placement between and in contact with the skin surface and said wicking material layer; and

inlet and outlet ports formed in said overdrape and configured for fluid inflow and outflow to and from said external fluid transfer component, respectively.

14. The dressing assembly according toclaim 13, which includes:

a porous, fluid-permeable mat between said wicking material layer and said external fluid transfer component, said mat and said wicking material layer configured for conveying fluid from said wound or incision to said external fluid transfer component for draining said dressing assembly; and

said external portions of said drain strips configured for adhesively attaching to the overdrape.

15. The dressing assembly according toclaim 13, which includes:

said inlet and outlet ports formed in an outer surface of said overdrape.

16. The dressing assembly according toclaim 15, which includes:

said external fluid transfer component having a perimeter; and

said inlet and outlet ports located in said overdrape at said external fluid transfer component perimeter.

17. A method of treating a closed wound or incision, which comprises the steps of:

providing a negative pressure source;

locating an internal fluid transfer component comprising a drain strip within said wound or incision;

placing a wick over the closed wound or incision in contact with the drain strip;

placing an external fluid transfer component over the wound or incision;

placing an overdrape with a perimeter over said fluid transfer component;

adhesively connecting said overdrape perimeter to a skin surface surrounding said wound or incision;

providing said fluid transfer component with a recoil core including a surface and a wicking material layer engaging same; and

connecting said negative pressure source to said external fluid transfer component; and

transferring fluid from the wound or incision under negative pressure to said external fluid transfer component via said drain strip.

18. The method ofclaim 17, which includes the additional steps of providing said drain strip with an internal portion located within said wound or incision and an external portion located externally thereto.

19. The method ofclaim 18, which includes the additional steps of:

providing a sensor connected to said external fluid transfer component;

sensing a characteristic of said external fluid transfer component and providing an output signal corresponding to said characteristic;

providing a controller connected to said sensor and receiving input signals therefrom; and

providing an output signal from said controller to said negative pressure source and thereby controlling the operation of said negative pressure source in response to a characteristic of said external fluid transfer component.

20. The method ofclaim 19, which includes the additional steps of:

providing a feedback loop connected to said controller output and to said controller; and

said feedback loop providing an output signal corresponding to said controller output and inputting same to said controller in said feedback loop.

21. The method ofclaim 17, which includes the additional steps of:

applying a subdermal hemostatic pressure via said external fluid transfer component and thereby providing a hemostasis treatment to said wound or incision.

Images